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This case demonstrates that PET imaging with SP 124 sp I-AT-01 may detect cardiac amyloidosis when other currently available imaging modalities do not. 3 Evuzamitide as SPECT/CT Imaging Agent for Diagnosis of Transthyretin Amyloidosis. [Extracted from the article]

Most cardiac imaging conferences have adopted social media as a means of disseminating conference highlights to a global audience well beyond the confines of the conference location. A deliberate and thoughtful social media campaign has the potential to increase the reach of the conference and allow for augmented engagement. The coronavirus disease 2019 (COVID-19) pandemic triggered a radical transformation in not just the delivery of healthcare but also the dissemination of science within the medical community. In the past, in-person medical conferences were an integral annual tradition for most medical professionals to stay up to date with the latest in the field. Social distancing requirements of the COVID-19 pandemic resulted in either cancelling medical conferences or shifting to a virtual format. Following suit, for the first time in its history, the 2021 Society for Cardiovascular Magnetic Resonance (SCMR) annual meeting was an all-virtual event. This called for a modified social media strategy which aimed to re-create the sociability of an in-person conference whilst also promoting global dissemination of the science being presented. This paper describes the employment of social media as well as the evolution through the SCMR scientific sessions for 2020 and 2021 that serves as a model for future cardiovascular conferences. [ABSTRACT FROM AUTHOR]

The plenary session ended with a talk by ASNC President Dr. Dorbala who discussed the use of PET imaging in cardiac amyloidosis. When there is clinical suspicion and in the presence of typical imaging features on either echocardiography, PET or CMR, Tc SP 99m sp PYP imaging should be used in conjunction with free light chain testing to diagnose cardiac amyloidosis. Dr. Ananthasubramaniam MD FASNC made a compelling argument for the adoption of a "cardiovascular imaging rotation" by cardiology fellowship programs rather than rotating in "silos" of echo, nuclear or CT. [Extracted from the article]

The high diagnostic accuracy of Tc-99m PYP, along with the absence of paraproteinemia, is very specific for TTR-CA, obviating the need for endomyocardial biopsies in most patients with suspected TTR-CA. PYP SPECT aides in identifying no myocardial isotope uptake when activity was noted on A 1-hour and B 3-hour planar PYP imaging. With the rapid evolution in imaging-based diagnosis of cardiac amyloidosis and the expected increase in the performance of clinically indicated Tc-99m PYP studies, there is an ongoing need for focused education. [Extracted from the article]

The intravascular ventricular assist system (iVAS) is the first minimally invasive, long-term, ambulatory counter-pulsation device that is currently being investigated as a bridge-to-transplant option for patients with advanced heart failure (HF). Ventricular tachycardia (VT) is a common complication in patients with advanced HF. Catheter ablation with substrate modification is an effective management strategy. We describe, to the best of our knowledge, the first reported case of VT ablation in a patient with the NuPulse iVAS device. An 82-year-old male came to the ED as his defibrillator discharged 4 times over 48 hours. He had a past history of ACC/AHA Stage D HFrEF (EF of 35%) due to ischemic cardiomyopathy. Given his advanced HF, he was enrolled in the iVAS trial and was implanted in 2019. On arrival, his BP was 172/99 mmHg and HR was 114/min. He was mildly hypervolemic on exam. CXR revealed mild pulmonary vascular congestion (Fig. 1B). ECG showed VT with a rate of 120/min (Fig. 1A). He was given IV procainamide, which transiently converted him to his baseline ventricular-paced rhythm, and his ICD was re-programmed to pace-terminate VT > 102/min. He was then loaded with IV lidocaine. Yet, he continued to have runs of VT. The next day, he underwent an adenosine nuclear stress test which showed a large severe fixed defect in the inferior and inferolateral regions suggestive of scar (Fig 1C). The following day, he underwent a VT ablation. A trans-septal approach was used to enter the LV and the scar was mapped (Fig 1D & E). Interestingly, every time radiofrequency ablation was delivered, there was electromagnetic interference with the iVAS device ECG leads which caused it to turn off. The patient became hypotensive during these episodes and dobutamine was used intra-procedurally for ionotropic support. Ablation was delivered in short bursts to allow the iVAS device to function intermittently, which prolonged the procedure time. The patient tolerated the procedure well and he has not had any recurrent VT. Long term mechanical circulatory support devices are an exciting emerging field. Complications of advanced HF include VT which is often difficult to control with medication alone and benefits from ablation. However, it appears that electromagnetic interference from radiofrequency ablation delivery impairs function of the iVAS ECG leads which gate the inflation & deflation of the counter-pulsation balloon to the cardiac cycle. Future iterations of the device must consider alternative triggers, such as being able to connect the device's ECG input to surface electrodes which would not be compromised during ablation delivery. [ABSTRACT FROM AUTHOR]

Lupus is known as the great masquerader for its myriad manifestations. Men comprise only 10% of adult lupus patients. Myopericarditis is seen infrequently with an incidence of 9% and more commonly in African Americans. A 32 year old Caucasian male came to the ED for worsening dyspnea. History was notable for hair loss, a facial rash, occasional pleuritic chest pain and weight loss. Hemoglobin: 9.5 mg/dl, creatinine: 1.1 mg/dl and pro-BNP: 43,448 pg/ml. UA revealed hematuria and proteinuria. ECG showed sinus tachycardia with non-specific T wave changes. CXR showed bilateral pleural effusions. Echo revealed an EF of 24% with a dilated and globally hypokinetic LV, mitral regurgitation and a small pericardial effusion. His presentation of multi-system involvement tipped further investigation of systemic illnesses. ANA, DSDNA were positive with low C3 and C4. CMR was consistent with myopericarditis and endomyocardial biopsy confirmed this. He was treated with pulse dose steroids and rituximab before transitioning to mycophenolate. 1 month follow up echo showed improvement in LV function with EF of 47%. A thorough history was key to identifying the atypical presentation of lupus in this young Caucasian male presenting with heart failure. This case highlights one of few scenarios where immunosuppressive therapy is used in Cardiology. Advancements in multimodal imaging mean such complex diagnoses will be detected more, emphasizing the need to familiarize ourselves with such treatments to best serve our patients. [ABSTRACT FROM AUTHOR]